<%@ page language="java" contentType="text/html; charset=UTF-8"
	pageEncoding="UTF-8"%>
<%@include file="/WEB-INF/templates/common/taglib.jsp"%>
<%@ taglib prefix="fmt" uri="http://java.sun.com/jsp/jstl/fmt"%>

 <!DOCTYPE html>
<html>
<head>
    <meta charset="utf-8">
    <meta http-equiv="X-UA-Compatible" content="IE=edge" />
   <title>${title}</title>
   <link rel="stylesheet" href="${basePath}/static/bootstrap/css/bootstrap.css"/>
    <link href="${basePath}/static/css/login.css" rel="stylesheet" type="text/css">
    <link href="${basePath}/static/css/basic.css" rel="stylesheet" type="text/css"> 
    <link href="${basePath}/static/css/list.css" rel="stylesheet" type="text/css">
    <%-- <link rel="stylesheet" href="${basePath}/static/css/content_leftNav.css"/> --%>
   <%--  <link rel="stylesheet" href="${basePath}/static/css/FrontControl.css"/> --%>
    <script  type="text/javascript" src="${basePath}/static/js/jquery.min.js"></script>
   <%--  <link rel="stylesheet" href="${basePath}/static/bootstrap/css/bootstrap.css"/> --%>
	<script type="text/javascript" src="${basePath}/static/js/bootstrap.js"></script>
	<script  type="text/javascript" src="${basePath}/static/My97DatePicker/WdatePicker.js"></script>
	<script type="text/javascript" src="${basePath}/static/page/jqPaginator/jqPaginator.js"></script>
	<script type="text/javascript" src="${basePath}/static/js/verification.js"></script>
	<script type="text/javascript" src="${basePath}/static/js/util.js"></script>
	<style type="text/css">
	.input_list{
		border: 1px red solid;	
	}
	</style>
</head>
<body>
<!--头部-->
	<%@include file="/WEB-INF/templates/common/header.jsp"%>
	<!------导航条-->
	<%@include file="/WEB-INF/templates/common/navigation.jsp"%>

<!--内容部分-->
<div class="list_main lay_out" class="clearfix">
    <div class="list_DH">
        <%@include file="/WEB-INF/templates/common/qualityNav.jsp"%>
    </div>
    <div class="list_NR">
        <div class="loc">
            <h3 style="margin:0">数据补录</h3>
        </div>
        <div class="list_con_table">
             <div class="search_table">
                <ul class="clearfix" style="margin-bottom:0;">
                	<form method="post" style="height:228px;" id="form1" action="${basePath}/scan/addPatientCont">
                    <li class="Label_1">姓名：<span class="Lable_6">*</span></li>
                    <li class="Label_2"><input class="input_box" type="text"  name='name' id='name' value='' title="" required /></li>
                    <li class="Label_1">身份证号：<span class="Lable_6">*</span></li>
                    <li class="Label_2"><input class="input_box" type="text"  name='idNumber' id='idNumber' value='' title="" /></li>
                     <li class="Label_1">性别：&nbsp;</li>
                    <li class="Label_2">
                    <select name="sex" style="width:95%;height:30px">
                    		<option value="">请选择性别</option>
                    		<c:forEach items="${sexList}" var="sex">
                    			<option value="${sex.id}">${sex.name}</option>
                    		</c:forEach>
                    	</select>
                    <li class="Label_1">联系方式：<span class="Lable_6">*</span></li>
                    <li class="Label_2"><input class="input_box" type="text"  name='mobilePhone' id='mobilePhone' value='' title="" /></li>
                    <li class="Label_1">出生日期：&nbsp;</li>
                    <li class="Label_2"><input class="input_box" type="text"  onFocus="WdatePicker()"  name='birthday' id='' value='' /></li>
                    <li class="Label_1">家庭住址：&nbsp;</li>
                    <li class="Label_2"><input class="input_box" type="text"  name='addressNo' id='' value=''  /></li>
                    <li class="Label_1">识别码：<span class="Lable_6">*</span></li>
                     <li class="Label_2"><input class="input_box" type="text"  name="treatmentNo" id='treatmentNo' value='' title=""/></li>
                    <li class="Label_1">病案号：<span class="Lable_6">*</span></li>
                    <li class="Label_2"><input class="input_box" type="text"  name='onlyId' id='onlyId' value=''  title=""/></li>
                    <li class="Label_1"><span class="Lable_6">*</span>就诊保密标识：</li>
                   
                    <li class="Label_2">
                    	<select name="treatmentSignId" name="treatmentSignId" id="treatmentSignId" style="width:95%;height:30px" title="">
                    		<option value="">请选择保密类型</option>
                    		<c:forEach items="${treatmentSignlist}" var="sign">
                    			<option value="${sign.id}">${sign.name}</option>
                    		</c:forEach>
                    	</select>
                    	<input class="input_box" type="text"  name='' id='' value='' />
                    </li>
                    <input type="hidden" name="hospitalId" value="1"/>
                    <input class="input_box" type="hidden"  name='treatmentTypeId' id='' value='1' /> 
                     <li class="Label_1">入院日期：</li>
                    <li class="Label_2"><input class="input_box" type="text" onFocus="WdatePicker()"  name='inHospitalDate' id='inHospitalDate' value='' /></li>
                    <li class="Label_1"><span class="Lable_6">*</span>入院科室：</li>
                    <li class="Label_2">
                    	 <select name="inDeptId" id="inDeptId" style="width:95%;height:30px" title="">
                    		<option value="">请选择科室：</option>
                    		<c:forEach items="${officeList}" var="office">
                    			<option value="${office.id}">${office.name}</option>
                    		</c:forEach>
                    	</select>
                    </li>
            

               		<input type="hidden" name=""/>
                    <li class="Label_1"><span class="Lable_6">*</span>入院方式：</li>
                    <li class="Label_2">
                    	<select name="inHospitalTypeId" style="width:95%;height:30px" title="">
                    		<option value="">请选择入院方式</option>
                    		<c:forEach items="${inhospitaltypeList}" var="inhospital">
                    			<option value="${inhospital.id}">${inhospital.name}</option>
                    		</c:forEach>
                    	</select></li>

                    <li class="Label_1">出院日期：<span class="Lable_6">*</span></li>
                    <li class="Label_2"><input class="input_box" type="text" onFocus="WdatePicker()"  name='outHospitalDate' id='outHospitalDate' value='' onFocus="WdatePicker()" title=""/></li>
                    <li class="Label_1">出院科室：</li>
                    <li class="Label_2">
                    	<select name="outDeptId" id="outDeptId" style="width:95%;height:30px">
                    		<option value="">请选择科室：</option>
                    		<c:forEach items="${officeList}" var="office">
                    			<option value="${office.id}">${office.name}</option>
                    		</c:forEach>
                    	</select>
                    </li>
                    <li class="Label_1">离院方式：</li>
                    <li class="Label_2">
                    <select name="outHospitalTypeId" style="width:95%;height:30px">
                    		<option value="">请选择离院方式</option>
                    		<c:forEach items="${outhospitaltypeList}" var="outhospital">
                    			<option value="${outhospital.id}">${outhospital.name}</option>
                    		</c:forEach>
                    	</select>
                    </li>
                    <!-- <input class="input_box" type="text"  name='outHospitalTypeId' id='' value='' /> --></li>
                    <li class="Label_5">
                        <a id="Add">新增</a>
                        
                    </li>
                    </form>
                </ul>
            </div> 
          
        </div>
       
    </div>
</div>



<!------页脚部分--------->
<%@include file="/WEB-INF/templates/common/footer.jsp"%>

<!-- JS -->
<script type="text/javascript">


</script>
</body>
</html> 